Vast cache of Kaiser patient details was kept in private home

Federal and state officials are investigating whether healthcare giant Kaiser Permanente violated patient privacy in its work with an Indio couple who stored nearly 300,000 confidential hospital records for the company.

The California Department of Public Health has already determined that Kaiser "failed to safeguard all patients' medical records" at one Southern California hospital by giving files to Stephan and Liza Dean for about seven months without a contract. The couple's document storage firm kept those patient records at a warehouse in Indio that they shared with another man's party rental business and his Ford Mustang until 2010.

Until this week, the Deans also had emails from Kaiser and other files listing thousands of patients' names, Social Security numbers, dates of birth and treatment information stored on their home computers.

The state agency said it was awaiting more information from Kaiser on its "plan of correction" before considering any penalties.

Officials at the U.S. Department of Health and Human Services began looking into Kaiser's conduct last year after receiving a complaint from the Deans about the healthcare provider's handling of patient data, letters from the agency show. Kaiser said it hadn't been contacted by federal regulators, and a Health and Human Services spokesman declined to comment.

Kaiser said it remained confident that this patient information was never disclosed or accessed inappropriately. It said that some employees were disciplined because company policies were not followed and that it had informed regulators of the steps it had taken to ensure this type of incident didn't happen again.

"Kaiser Permanente is committed to protecting the medical and personal privacy of its patients," spokesman John Nelson said. "In retrospect, we certainly wish we'd never done business with Mr. Dean."

Even with tougher government oversight of medical privacy in recent years, this case underscores how confidential patient information remains vulnerable in the hands of big healthcare institutions and legions of outside contractors.

"Kaiser has shown extraordinary recklessness in this situation," said Beth Givens, director of the Privacy Rights Clearinghouse in San Diego. "Healthcare companies have to make sure their contractors adhere to ironclad security practices."

Federal and state laws impose strict standards on anyone dealing with patient information. The privacy rule of the federal Health Insurance Portability and Accountability Act, known as HIPAA, bans the unauthorized disclosure of individuals' medical records and requires healthcare providers and vendors, such as billing and storage companies, to protect the information.

Despite those rules, personal medical information of 21 million people nationwide has been improperly exposed since 2009, according to federal data. Last year, Blue Cross Blue Shield of Tennessee agreed to pay $1.5 million to resolve allegations it violated federal law after 57 computer hard drives with patient information were stolen from an outside facility.

In October, Kaiser sued the Deans in Riverside County Superior Court, accusing them of violating their contract by not returning all of its patient information two years ago when Kaiser picked up the paper records.

In court filings, Kaiser said the Deans put patient data at risk by leaving two computer hard drives in their garage with the door open. In response, Stephan Dean moved them to a spare room. On a recent day they sat next to a red recliner where Ziggy, the family's black-and-white cat, curled up for a nap. Dean said those hard drives contained spreadsheets on thousands of Kaiser patients, prepared at the company's request.

At one point, Dean told Kaiser he was planning to contact patients about the whereabouts of their medical information because he felt Kaiser hadn't taken proper precautions. The company sought a temporary restraining order against Dean, barring him from disclosing any confidential information. A Superior Court judge granted Kaiser's request until Thursday, when another hearing is scheduled.

Dean, 47, got his foot in the door at Kaiser from his previous work labeling paper folders for courthouses, hospitals and doctors.

But the demand for folders was slipping as hospitals and doctors used computers more. Kaiser was at the forefront of this as it invested billions of dollars in its HealthConnect system, which it bills as the largest private-sector electronic health record in the world. Kaiser, with more than 9 million customers, is the nation's largest nonprofit insurer and hospital system.

Dean said his small business, Sure File Filing Systems, got a big break when Kaiser acquired the Moreno Valley Community Hospital in 2008. The company needed to organize and clear out thousands of old patient files and it gave the job to the Deans, Kaiser records show.

In August 2008, the Deans started packing up thousands of files from Moreno Valley and moving them to the warehouse in Indio.

Hospital clerks routinely messaged Dean asking him to pull records on specific patients, emails sent by Kaiser to Sure File show. Dean said some Kaiser employees would put the patient's full name in the subject line of the email, and other messages listed the patient's Social Security number, date of birth, doctors' names and treatment dates. One message started, "Good Morning Sure File," and requested adoption records for a child.

Dean said Kaiser showed little concern for patient privacy in handling those requests. Only one out of more than 600 emails from Kaiser was password-protected with encryption, he said. Many medical providers use such technology so information isn't visible to others.

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Economy maintains job growth as unemployment holds at 7.8%

WASHINGTON -- The U.S. job market continued to show slow and steady improvement in December as employers added 155,000 jobs last month, in line with analysts' expectations and at the average monthly pace for the last two years.

The jobless rate held steady at 7.8% as November's unemployment figure was revised up from the initial estimate of 7.7%, the Bureau of Labor Statistics said Friday.

The good news in the report is that worries about the so-called fiscal cliff of tax hikes and budget cuts didn't derail hiring last month, as some had feared it could. Healthcare hiring was very strong, manufacturing bounced back and construction added a solid batch of jobs, although part of that was likely due to recovery efforts from Superstorm Sandy that struck the Northeast in late October.

On the other hand, some analysts were hoping for stronger overall job growth last month, closer to 200,000, as there were some indications earlier this week that hiring in the private sector might have accelerated. But the retail sector cut back its staffing, as did the information industry. Government employers, mostly local schools, shed 13,000 from its payrolls. Temporary-help employment was flat.

The nation's unemployment rate of 7.8%, also matched in September, is the lowest since January 2009. Unlike November, last month workers didn't exit the job market. The labor force actually grew. More reported having jobs, but the ranks of the unemployed also increased, to 12.2 million last month.

Almost 40% of the unemployed said they had been without jobs for six months or longer -- a statistic that has shown little improvement over the years, which is particularly worrisome as more of these workers will find it increasingly difficult to find work as their skills atrophy and they become discouraged.

Analysts were expecting job growth of about 150,000 in December, which is about what the economy has been generating on average for the last two years. Although that is a decent pace, certainly enough to absorb new entrants into the labor force, it's not strong enough to bring down unemployment quickly and create opportunities for the large number of jobless workers.

As of December, the nation had about 134 million payroll jobs -- still 4 million fewer than at the end of 2007 when the economy began its descent into recession.

Looking ahead, economists aren't expecting any pickup in hiring in the near term. In fact, job growth could slide back a bit, analysts say, until policymakers resolve the thorny issues of raising the debt ceiling and budget deficit problems. Lawmakers averted most of the "fiscal cliff" earlier in the week, but they let payroll taxes rise to previous rates, which is expected to slow consumer spending a bit and could take a bite out of hiring in the next few months.

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Fed to tie interest rate to job gains

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Actor Dempsey: Coffee chain bid appears successful

SEATTLE (AP) — Actor Patrick Dempsey said it appears his bid to buy a small coffee chain has prevailed in a bankruptcy auction that included Starbucks Corp.

Late Thursday night, Dempsey announced that his company, Global Baristas LLC, made the winning bid for Tully's Coffee. He noted in a KOMO-TV interview that a bankruptcy judge will have the final say on Jan. 11. Still, Dempsey tweeted "We got it! Thank you Seattle!"

Dempsey's company will pay $9,150,000 for Tully's and complete the purchase later this month after the court hearing, he said in a statement.

"I'm thrilled that we won and I'm even more excited about saving Tully's Coffee and its hundreds of jobs," he said. "Tully's is a great company with committed employees, and with its base in Seattle, one of the world's greatest cities, I'm confident we will be able to successfully build the brand and help grow the economy. "

Tully's Coffee has 47 company-owned locations in Washington and California. The company, with more than 500 employees, filed for Chapter 11 bankruptcy protection in October.

Dempsey, who gained the nickname "McDreamy" on the TV show "Grey's Anatomy" set in a fictional Seattle hospital, has said he wants to rescue the chain.

"Seattle has been very good to me over my career, and I am honored to have the privilege to own Tully's and work closely with the company's employees," he said in his statement.

After Thursday's auction, Starbucks spokesman Zack Hutson confirmed his company participated and "is currently in a back-up position" for some of Tully's assets. The final certification of the winning bid won't occur until the Jan. 11 bankruptcy court hearing, Hutson said.

"We have to wait until next week to make sure everything — I believe the 11th — to make sure it's all finalized," Dempsey told KOMO-TV.

The Starbucks spokesman said his company made an offer for 13 of Tully's company-owned stores in the Puget Sound region plus 12 outlets at Boeing Co. sites. Hutson said another bidder made an offer for all other assets — and is in a back-up position for those.

Also in the running was Baristas Coffee, which operates a chain of drive-thru espresso stands featuring female employees in skimpy outfits.

Both Starbucks and Tully's are based in Seattle.

The auction process was not public.

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Scant Proof Is Found to Back Up Claims by Energy Drinks

Energy drinks are the fastest-growing part of the beverage industry, with sales in the United States reaching more than $10 billion in 2012 — more than Americans spent on iced tea or sports beverages like Gatorade.

Their rising popularity represents a generational shift in what people drink, and reflects a successful campaign to convince consumers, particularly teenagers, that the drinks provide a mental and physical edge.

The drinks are now under scrutiny by the Food and Drug Administration after reports of deaths and serious injuries that may be linked to their high caffeine levels. But however that review ends, one thing is clear, interviews with researchers and a review of scientific studies show: the energy drink industry is based on a brew of ingredients that, apart from caffeine, have little, if any benefit for consumers.

“If you had a cup of coffee you are going to affect metabolism in the same way,” said Dr. Robert W. Pettitt, an associate professor at Minnesota State University in Mankato, who has studied the drinks.

Energy drink companies have promoted their products not as caffeine-fueled concoctions but as specially engineered blends that provide something more. For example, producers claim that “Red Bull gives you wings,” that Rockstar Energy is “scientifically formulated” and Monster Energy is a “killer energy brew.” Representative Edward J. Markey of Massachusetts, a Democrat, has asked the government to investigate the industry’s marketing claims.

Promoting a message beyond caffeine has enabled the beverage makers to charge premium prices. A 16-ounce energy drink that sells for $2.99 a can contains about the same amount of caffeine as a tablet of NoDoz that costs 30 cents. Even Starbucks coffee is cheap by comparison; a 12-ounce cup that costs $1.85 has even more caffeine.

As with earlier elixirs, a dearth of evidence underlies such claims. Only a few human studies of energy drinks or the ingredients in them have been performed and they point to a similar conclusion, researchers say — that the beverages are mainly about caffeine.

Caffeine is called the world’s most widely used drug. A stimulant, it increases alertness, awareness and, if taken at the right time, improves athletic performance, studies show. Energy drink users feel its kick faster because the beverages are typically swallowed quickly or are sold as concentrates.

“These are caffeine delivery systems,” said Dr. Roland Griffiths, a researcher at Johns Hopkins University who has studied energy drinks. “They don’t want to say this is equivalent to a NoDoz because that is not a very sexy sales message.”

A scientist at the University of Wisconsin became puzzled as he researched an ingredient used in energy drinks like Red Bull, 5-Hour Energy and Monster Energy. The researcher, Dr. Craig A. Goodman, could not find any trials in humans of the additive, a substance with the tongue-twisting name of glucuronolactone that is related to glucose, a sugar. But Dr. Goodman, who had studied other energy drink ingredients, eventually found two 40-year-old studies from Japan that had examined it.

In the experiments, scientists injected large doses of the substance into laboratory rats. Afterward, the rats swam better. “I have no idea what it does in energy drinks,” Dr. Goodman said.

Energy drink manufacturers say it is their proprietary formulas, rather than specific ingredients, that provide users with physical and mental benefits. But that has not prevented them from implying otherwise.

Consider the case of taurine, an additive used in most energy products.

On its Web site, the producer of Red Bull, for example, states that “more than 2,500 reports have been published about taurine and its physiological effects,” including acting as a “detoxifying agent.” In addition, that company, Red Bull of Austria, points to a 2009 safety study by a European regulatory group that gave it a clean bill of health.

But Red Bull’s Web site does not mention reports by that same group, the European Food Safety Authority, which concluded that claims about the benefits in energy drinks lacked scientific support. Based on those findings, the European Commission has refused to approve claims that taurine helps maintain mental function and heart health and reduces muscle fatigue.

Taurine, an amino acidlike substance that got its name because it was first found in the bile of bulls, does play a role in bodily functions, and recent research suggests it might help prevent heart attacks in women with high cholesterol. However, most people get more than adequate amounts from foods like meat, experts said. And researchers added that those with heart problems who may need supplements would find far better sources than energy drinks.

Hiroko Tabuchi contributed reporting from Tokyo and Poypiti Amatatham from Bangkok.

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U.S. unemployment steady at 7.8%; 155,000 jobs added in December

WASHINGTON — U.S. employers added 155,000 jobs in December, a steady gain that shows hiring held up during tense fiscal cliff negotiations in Washington.

The solid job growth wasn't enough to push down the unemployment rate, which stayed at 7.8% last month, according to the Labor Department's report Friday. November's rate was revised higher from an initially reported 7.7%.

Stock futures rose modestly after the report was released.

Robust hiring in manufacturing and construction fueled the December gains. Construction firms added 30,000 jobs, the most in 15 months. That likely reflects additional hiring needed to rebuild after Superstorm Sandy and also solid gains in home building that have contributed to a housing recovery.

Manufacturers gained 25,000, the most in nine months.

Even with the gains, hiring is far from accelerating. Employers added an average of 153,000 jobs a month last year, matching the monthly average in 2011. Employers added 1.84 million jobs in 2012, the same as the previous year.

Still, the stable hiring last month means employers didn't panic during the high-stakes talks between Congress and the White House over tax increases and spending cuts that were not resolved until the new year. That's a good sign for the coming months, since more budget disputes are expected.

While the parties reached a deal this week that removed the threat of income tax increases on most Americans, they postponed the more difficult decisions on cutting spending. And the government must also increase its $16.4 trillion borrowing limit by around late February or risk defaulting on its debt.

There were indications in the December report of the job market's ongoing sluggishness. The number of Americans unemployed actually rose 164,000 to 12.2 million. The unemployment figures come from a separate survey of households, while the job counts are derived from a survey of businesses.

Still, the economy is improving. Layoffs are declining, and the number of people who sought unemployment aid in the past month is near a four-year low.

The once-battered housing market is recovering. Companies ordered more long-lasting manufactured goods in November, a sign they are investing more in equipment and software. And Americans spent more in November. Consumer spending drives nearly 70% of economic growth.

Manufacturing is getting a boost from the best auto sales in five years. Car sales jumped 13 percent in 2012 to 14.5 million. And Americans spent more at the tail end of the holiday shopping season, boosting overall sales that had slumped earlier in the crucial two-month period.

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Bieber urges crackdown on paparazzi after photographer's death

Justin Bieber and his collection of exotic cars have been tantalizing targets for celebrity photographers ever since the young singer got his driver's license.

A video captured the paparazzi chasing Bieber through Westside traffic in November. When Bieber's white Ferrari stops at an intersection, the video shows the singer turning to one of the photographers and asking: "How do your parents feel about what you do?"

A few months earlier, he was at the wheel of his Fisker sports car when a California Highway Patrol officer pulled him over for driving at high speeds while trying to outrun a paparazzo.

This pursuit for the perfect shot took a fatal turn Tuesday when a photographer was hit by an SUV on Sepulveda Boulevard after taking photos of Bieber's Ferrari. And the singer now finds himself at the center of the familiar debate about free speech and the aggressive tactics of the paparazzi.

Since Princess Diana's fatal accident in Paris in 1997 while being pursued by photographers, California politicians have tried crafting laws that curb paparazzi behavior. But some of those laws are rarely used, and attorneys have challenged the constitutionality of others.

On Wednesday, Bieber went on the offensive, calling on lawmakers to crack down.

"Hopefully this tragedy will finally inspire meaningful legislation and whatever other necessary steps to protect the lives and safety of celebrities, police officers, innocent public bystanders and the photographers themselves," he said in a statement.

It remained unclear if any legislators would take up his call. But Bieber did get some support from another paparazzi target, singer Miley Cyrus.

She wrote on Twitter that she hoped the accident "brings on some changes in '13 Paparazzi are dangerous!"

Last year, a Los Angeles County Superior Court judge threw out charges related to a first-of-its-kind anti-paparazzi law in a case involving Bieber being chased on the 101 Freeway by photographer Paul Raef. Passed in 2010, the law created punishments for paparazzi who drove dangerously to obtain images.

But the judge said the law violated 1st Amendment protections by overreaching and potentially affecting such people as wedding photographers or photographers speeding to a location where a celebrity was present.

The L.A. city attorney's office is now appealing that decision.

Raef's attorney, Dmitry Gorin, said new anti-paparazzi laws are unnecessary.

"There are plenty of other laws on the books to deal with these issues. There is always a rush to create a new paparazzi law every time something happens," he said. "Any new law on the paparazzi is going to run smack into the 1st Amendment. Truth is, most conduct is covered by existing laws. A lot of this is done for publicity."

Coroner's officials have not identified the photographer because they have not reached the next of kin. However, his girlfriend, Frances Merto, and another photographer identified him as Chris Guerra.

The incident took place on Sepulveda Boulevard near Getty Center Drive shortly before 6 p.m. Tuesday. A friend of Bieber was driving the sports car when it was pulled over on the 405 Freeway by the California Highway Patrol. The photographer arrived near the scene on Sepulveda, left his car and crossed the street to take photos. Sources familiar with the investigation said the CHP told him to leave the area. As he was returning to his vehicle, he was hit by the SUV.

Law enforcement sources said Wednesday that it was unlikely charges would be filed against the driver of the SUV that hit the photographer.

Veteran paparazzo Frank Griffin took issue with the criticism being directed at the photographer as well as other paparazzi.

"What's the difference between our guy who got killed under those circumstances and the war photographer who steps on a land mine in Afghanistan and blows himself to pieces because he wanted the photograph on the other side of road?" said Griffin, who co-owns the photo agency Griffin-Bauer.

"The only difference is the subject matter. One is a celebrity and the other is a battle. Both young men have left behind mothers and fathers grieving and there's no greater sadness in this world than parents who have to bury their children."

Others, however, said the death focuses attention on the safety issues involving paparazzi

"The paparazzi are increasingly reckless and dangerous. The greater the demand, the greater the incentive to do whatever it takes to get the image," said Blair Berk, a Los Angeles attorney who has represented numerous celebrities. "The issue here isn't vanity and nuisance, it's safety."

richard.winton@latimes.com

andrew.blankstein@latimes.com

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Fake John le Carré Twitter Account Fakes J.K. Rowling’s Fake Twitter Death

We’ve seen “Cormac McCarthy” Tweet apocalyptic non sequiturs. “Philip Roth” promised us a bite-sized short story. Now a fake Twitter account for British spy novelist John le Carré is spreading bizarre death rumors about J.K. Rowling. After a few days of Tweeting harmless missives, the week-old handle @JLecarre dropped this would-be bombshell on its nearly 2,500 followers Wednesday morning: 

A terrible news. My publisher phones me announcing that J.K. Rowling dies by accident. Few minutes ago. No words!

— John le Carré (@JLecarre) January 2, 2013

OK, there are at least three dead-giveaways that this is a fake account. One: If J.K. Rowling had died, does anyone credibly think John le Carré would be the one breaking the news? Rowling and le Carré don’t even share a publisher—he’s with Penguin and she’s printed by Little, Brown and Company—making this story even more implausible. Two: As noted by le Carré’s literary agent Jonny Geller, the “L” in the author’s name shouldn’t be capitalized, as it is in the handle of this hoax account. Three: Phrases like “a terrible news” and “my publisher phones me” sound more like snippets from an ESL workbook than lines from an author praised for his chilly, controlled prose style. This could again be the work of Italian media troll Tommaso De Benedetti, who copped to creating a fake Philip Roth account recently. “Twitter works well for deaths,” he told The Guardian‘s Tom Kington, describing his M.O. for spreading misinformation about the deaths of public figures like Fidel Castro and Pedro Almodóvar. 

RELATED: Pippa’s Sales Figures Are Nothing to ‘Celebrate’; Salman Rushdie and John le Carré Call Truce

Too bad John le Carrè isn’t actually on Twitter, though. Imagine the flame wars he would get into with longtime adversary Salman Rushdie—who most certainly is on Twitter, and loves using it to throw literate shade. And too bad this isn’t the handiwork of someone with more imagination—someone like the unpublished Scottish novelist behind @cormaccmccarthy. Outed right here on The Atlantic Wire, Michael Crossan at least had the chops to fool Margaret Atwood and Twitter co-founder Jack Dorsey with dead-on spoofs of McCarthy’s writing: 

RELATED: Salman Rushdie’s Video Speech Gets Spiked; The World’s Priciest Books

Social Media News Headlines – Yahoo! News

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Depardieu, in tax fight, gets Russian citizenship

MOSCOW (AP) — Gerard Depardieu, the French actor who has waged a battle against a proposed super-tax on millionaires in his native country, has been granted Russian citizenship.

A brief announcement on the Kremlin website on Thursday revealed that President Vladimir Putin signed the citizenship grant following an application from the actor.

The former Oscar nominee and star of the movie "Green Card" has been vocal in his opposition to French President Francois Hollande's plans to raise the tax on earned income above €1 million ($1.33 million) to 75 percent from the current high of 41 percent. Russia has a flat 13-percent tax rate.

"I have never killed anyone, I don't think I've been unworthy, I've paid €145 million in taxes over 45 years," Depardieu wrote in an open letter in mid-December to Prime Minister Jean-Marc Ayrault, who had called the actor "pathetic."

"I will neither complain nor brag, but I refuse to be called 'pathetic,'" the 64-year-old actor wrote in his response.

A representative for the former Oscar nominee declined to say whether he had accepted the Russian offer, and refused all comment. Thursday was a holiday in Russia and officials from the Federal Tax Service and Federal Migration Service could not be reached for comment on whether the decision would require Depardieu to have a residence in Russia.

Depardieu said in his letter to Ayrault that he would surrender his passport and French social security card. In October, the mayor of a small Belgian border town announced that Depardieu had bought a house and set up legal residence there, a move that was slammed by the newly-elected Socialist government.

Najat Vallaud-Belkacem, the French government spokeswoman, didn't comment directly on Depardieu's tax fight, but drew a clear distinction between people who have personal or professional reasons to live abroad, and "French citizens who proclaim loudly and clearly that they they're exiling themselves for fiscal reasons."

She said Putin's offer "is an exclusive prerogative of the Russian chief of state."

Depardieu has had increasingly high-profile ties with Russia. Last October he visited the capital of Chechnya, Grozny, to celebrate the birthday of Chechen President Ramzan Kadyrov. And in 2011, he was in Russia's Arkhangelsk region to play the lead role in the film "Rasputin."

"You have to understand that Depardieu is a star in Russia," Vladimir Fedorovski, a Russian writer living in France, told the network Europe 1 on Thursday. "There are crowds around Depardieu. He's a symbol of France. He's a huge ambassador of French culture."

Though France's highest court struck down the two-year tax on Dec. 29, the government has promised to resubmit the law in a slightly different form soon. On Wednesday it estimated that the court decision to overturn the tax would cost it €210 million in 2013.

In an interview published Sunday, Depardieu told the Sunday Parisien that the court decision made no difference.

France's debt burden is around 90 percent of national income — not far off levels that have caused problems elsewhere in the 17-country eurozone.

Depardieu has made more than 150 films, among them the 1991 comedy "Green Card" about a man who enters into a marriage of convenience in order to get U.S. residency. Most famously, Depardieu was nominated for an Academy Award for his role as Cyrano de Bergerac in the 1990 film by the same name.

The Kremlin statement gave no information on why Putin made the citizenship grant, but the Russian president expressed sympathy with the actor in December, days after Depardieu reportedly said he was considering Russian citizenship.

"As we say, artists are easily offended and therefore I understand the feelings of Mr. Depardieu," Putin said.

Although France and Russia disagree sharply about how to resolve the civil war in Syria, the two countries have strong commercial relations. In 2011, Russia signed a contract worth more than €1 billion ($1.33 billion) Friday to buy two French warships — the largest military deal between a NATO country and Moscow.

Depardieu is well known in Russia, where he appears in an ad for Sovietsky Bank's credit card and is prominently featured on the bank's home page.

Depardieu is not the only high-profile Frenchman to object to the super-tax. Bernard Arnault — chief of the luxury goods and fashion giant LVMH and worth an estimated $41 billion — has also said he would leave for Belgium.

France's Civil Code says one must have another nationality in order to give up French citizenship because it is forbidden to be stateless. Thursday's decision by the Kremlin appears to fulfill that requirement.

____

Hinnant contributed from Paris. Silvie Corbet also contributed from Paris.

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Hillary Clinton Is Discharged From Hospital After Blood Clot

Hillary Rodham Clinton, whose globe-trotting tour as secretary of state was abruptly halted last month by a series of health problems, was discharged from a New York hospital on Wednesday evening after several days of treatment for a blood clot in a vein in her head.

The news of her release was the first welcome sign in a troubling month that grounded Mrs. Clinton — preventing her from answering questions in Congress about the State Department’s handling of the lethal attack on an American mission in Libya or being present when President Obama announced Senator John Kerry as his choice for her successor when she steps down as secretary of state.

“Her medical team advised her that she is making good progress on all fronts, and they are confident she will make a full recovery,” Philippe Reines, a senior adviser to Mrs. Clinton, said in a statement.

Mrs. Clinton, 65, was admitted to NewYork-Presbyterian/Columbia hospital on Sunday after a scan discovered the blood clot. The scan was part of her follow-up care for a concussion she sustained more than two weeks earlier, when she fainted and fell, striking her head. According to the State Department, the fainting was caused by dehydration, brought on by a stomach virus. The concussion was diagnosed on Dec. 13, though the fall had occurred earlier that week.

The clot was potentially serious, blocking a vein that drains blood from the brain. Untreated, such blockages can lead to brain hemorrhages or strokes. Treatment consists mainly of blood thinners to keep the clot from enlarging and to prevent more clots from forming, and plenty of fluids to prevent dehydration, which is a major risk factor for blood clots.

Photographed leaving the hospital, Mrs. Clinton and her husband, former President Bill Clinton, and their daughter, Chelsea, appeared elated. In a Twitter post on Wednesday, Chelsea Clinton said, “Grateful my Mom discharged from the hospital & is heading home. Even more grateful her medical team confident she’ll make a full recovery.”

Dr. David J. Langer, a brain surgeon and associate professor at Hofstra North Shore-LIJ School of Medicine, said that Mrs. Clinton would need close monitoring in the next days, weeks and months to make sure her doses of blood thinners are correct and that the clot is not growing. Dr. Langer is not involved in her care.

Mrs. Clinton’s illness cuts short what would have been a victory lap for her at the State Department. With only a few weeks before the end of President Obama’s first term — the time frame she set for her own departure — she will be able to do little more than say goodbye to her troops.

But she will, at least theoretically, be able to testify before the Senate and House about the attack on the American mission in Benghazi, Libya, which killed four Americans, including Ambassador J. Christopher Stevens. She was not able to appear at a hearing in December because of her illness. Republicans, who have sharply criticized the Obama administration’s handling of the attack and its aftermath, had demanded that she appear to explain the department’s role, though in recent days they have modulated their request.

Mrs. Clinton’s blood clot formed in a large vein along the side of her head, behind her right ear, between the brain and the skull. The vein, called the right transverse sinus, has a matching vessel on the left side. These veins drain blood from the brain; blockages can cause strokes or brain hemorrhages. But if only one transverse sinus is blocked, the vein on other side can usually handle the extra flow.

In one sense, Mrs. Clinton was lucky: a clot higher in this drainage system, in a vessel with no partner to take the overflow, would have been far more dangerous, according to Dr. Geoffrey T. Manley, the vice chairman of neurological surgery at the University of California, San Francisco. He is not involved in her care.

The fact that Mrs. Clinton had a blood clot in the past — in her leg, in 1998 — suggests that she may have a tendency to form clots, and may need blood-thinners long-term or even for the rest of her life, Dr. Manley said.

One major risk to people who take blood thinners is that the drugs increase bleeding, so blows to the head from falls or other accidents — like the fall that caused Mrs. Clinton’s concussion — become more dangerous, and more likely to cause a brain hemorrhage. Even so, the medication should not interfere with Mrs. Clinton’s career, Dr. Manley said.

“There are lots of people running around on anticoagulants today,” he said. “I don’t see any way it would have any long-term consequences.”

He also said there was no reason to think that this type of clot would recur; he said he had treated many patients for the same condition and had never seen one come back with it again.

Dr. Langer said the vein blocked by the clot might or might not reopen. Sometimes, he said, the clot persists and the body covers it with tissue that closes or narrows the blood vessel. As long as the vein on the other side of the head is open, there is no problem for the patient.

One thing that is unclear, and that may never be known for sure, is what caused Mrs. Clinton’s blood clot. Around the second week in December, she reportedly contracted a stomach virus that caused vomiting and dehydration, passed out, fell and struck her head. A concussion was diagnosed several days after the fall, on Dec. 13, and the public was told Sunday that she had a blood clot, though its location was not revealed until the next day.

She had several risk factors for clots, including dehydration and her previous history of a clot. In addition, women are more prone than men to this type of clot, particularly when dehydrated. The fall may also have been a factor, though it is not clear whether her head injury was serious enough to have caused a blood clot. The type of clot she had is far more likely to be associated with a skull fracture than with a concussion, several experts said.

Did overwork — frequent overseas trips, perpetual jet lag, high-pressure meetings — make her ill? Mrs. Clinton has kept up a punishing schedule since she declared her candidacy for president in 2007. Having logged more than 950,000 miles and visited 112 countries, she is one of the most-traveled secretaries of state in history. She has put on weight and in recent times appeared fatigued. But the same could be said of plenty of people who do not develop clots in their heads.

“You cannot tell me that her hard work resulted in this,” Dr. Langer said. “I can’t imagine that you could make that judgment.”

In theory, Dr. Manley said, exhaustion can weaken the immune system temporarily, and lower a person’s resistance to infections like the stomach virus that apparently started Mrs. Clinton’s problems. But in his opinion, the most important contributing factor to her blood clot was probably the head injury from her fall.

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World's 100 richest people got $241 billion richer in 2012

The richest people on the planet got even richer in 2012, adding $241 billion to their collective net worth, according to the Bloomberg Billionaires Index, a daily ranking of the world's 100 wealthiest individuals.

The aggregate net worth of the world's top 100 stood at $1.9 trillion at the market close Dec. 31, according to the index. Of the people who appeared on the final ranking of 2012, only 16 registered a net loss for the 12-month period.

"Last year was a great one for the world's billionaires," said John Catsimatidis, the billionaire owner of Red Apple Group Inc., in an email written poolside on his BlackBerry in the Bahamas. "In 2013, they will continue looking for investments around the world — and not necessarily in U.S. — that will give them an advantage."

Amancio Ortega, the Spaniard who founded retailer Inditex, was the year's biggest gainer. The 76-year-old tycoon's fortune increased to $57.5 billion, a gain of $22.2 billion, according to the index, as shares of the retailer that operates the Zara clothing chain rose 66.7%.

"It's an amazing company that has done great, and the gains are quite justified given its performance," said Christodoulos Chaviaras, an analyst at Barclays in London who's had an "equalweight" rating on Inditex for about a year. "Can they repeat that? It will be harder. A lot of the positive news is already reflected in the share price."

Global stocks soared in 2012. The MSCI World Index gained 13.2% during the year to close at 1338.50 on Dec. 31. The Standard & Poor's 500 index rose 13.4% to close at 1426.19.

European stocks surged in the second half of the year. The Stoxx Europe 600 index is up 19.6% since June 4, advancing as the European Central Bank introduced bond-buying programs, S&P upgraded Greece's debt and German business confidence rose more than forecast. The benchmark gauge's 14.4% advance for the year was the best annual return since 2009.

Carlos Slim, the telecommunications magnate who controls Mexico's America Movil, maintained his title as the richest person on Earth for the entire year. The 72-year-old's net worth rose $13.4 billion, or 21.6%, through Dec. 31, making him the second-biggest gainer by dollars.

Gains by Slim's industrial conglomerate, Grupo Carso, and Grupo Financiero Inbursa, his banking and insurance operation, more than offset the decline posted by America Movil, his biggest holding. The largest mobile phone operator in the Americas by subscribers fell 5.8% to close at 14.9 pesos at the end of the year.

U.S. software mogul Bill Gates, 57, ranks second on the list, trailing Slim by $12.5 billion. The Microsoft Corp. co-founder added $7 billion to his net worth as shares of the Redmond, Wash., company rose 2.9%. Microsoft stock accounts for less than 20% of the billionaire's fortune.

Warren Buffett, 82, lost his title as the world's third-richest man to Ortega on Aug. 6. The Berkshire Hathaway Inc. chairman gained $5.1 billion during the year, even after donating 22.3 million Berkshire Class B shares in July to charity. The billionaire, who has pledged to give away most of his fortune, spent much of the year pressing for higher taxes on the wealthy.

Ikea founder Ingvar Kamprad, 86, is the world's fifth-richest person with a $42.9-billion fortune. The complex ownership structure behind Ikea, the world's largest furniture retailer, became more transparent in August after Ikea's franchisor published its financial performance publicly for the first time. His net worth rose 16.6% in 2012.

Brazil's Eike Batista, 56, was the year's biggest loser by dollars, falling $10.1 billion. The commodities maven, who vowed a year ago that he'd become the world's wealthiest man by 2015, sold a 5.63% stake in his EBX Group Co. in March to Abu Dhabi's Mubadala Development Co.

As part of the deal, he pledged an unspecified additional stake in 2019 if he fails to meet a 5% annual return on the sovereign wealth fund's $2-billion investment, according to a person with knowledge of the deal. Batista now ranks 75th in the world with a net worth of $12.4 billion. On March 27, he was worth $34.5 billion and ranked 8th on the Bloomberg index.

Batista's former title as the richest Brazilian is now held by 73-year-old banker Jorge Paulo Lemann, who ranks 37th on the index with an $18.8-billion fortune. The country's second-richest person is Dirce Camargo, the matriarch behind Camargo Correa, the Sao Paulo conglomerate that has interests in cement, electricity and Havaianas flip-flops. Her net worth is $13.4 billion, according to the Bloomberg ranking.

Camargo, who doesn't appear on any other major international wealth ranking, is one of 54 billionaires the index uncovered during the year. Among the others: Hamdi Ulukaya, the 40-year-old Turkish immigrant owner of Chobani, the bestselling yogurt brand in the U.S.; South Africa's Nathan "Natie" Kirsh, 80, who amassed a $5.4-billion fortune in retail and real estate; and Elaine Marshall, 70, whose 14.6% ownership of closely held Koch Industries makes her the fourth-richest woman in America. She is worth $14.1 billion.

Koch Industries' two other shareholders, the brothers Charles and David Koch, are each worth $40.9 billion, up $7.1 billion, or 20.9%, for the year.

Oracle Corp. founder Larry Ellison rose $6.4 billion in 2012 as shares of the world's largest database company jumped 31.7%. Ellison, 68, who has more than tripled the amount of Oracle stock he has pledged against lines of credit in the last year, agreed to buy 98% of Hawaii's Lanai island. The 141-square-mile parcel with no traffic lights was purchased from billionaire David Murdock, the 89-year-old chairman of Dole Food Co., the world's largest producer of fresh fruit and vegetables.

The bulk of Ellison's fortune comes from his 23.5% stake in Oracle. He also has interests in software makers NetSuite Inc. and LeapFrog Enterprises Inc., as well as property holdings, including estates in California and Newport, R.I.

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